Despite scientific evidence supporting the care of patients with common chronic diseases, patients continue not to receive evidenced-based care, especially in rural practices. Problems preventing practice implementation include lack of financial incentives and a lack of understanding of the nature of primary care. Evidence suggests that multifaceted interventions are needed to improve utilization of research findings; however investigations have not attempted to apply these in rural practices. The primary objective of this study is to test the effectiveness of a multifaceted intervention program to improve the quality of care for high-risk diabetic patients in rural settings. The program to be tested is the Wellmark Incentive-Support to Encourage Quality Improvement (WISE Ql) a program based on the chronic care model. It applies aspects from each of the 6 components of the model, including 1) delivery system redesign, 2) health care organization, 3) clinic information systems, 4) decision support, 5) self-management support, and 6) community resources. This study is a prospective study to evaluate the impact of the WISE Ql program on health care quality. The study will enroll 200 patients at four rural primary care practices. Patients in the 2 intervention practices will receive the WISE Ql program to enhance health care quality, while patients in the 2 control practices will receive usual care. Both process and outcome measures will be evaluated. In addition, this study will identify contextual factors that enhance program effectiveness for further study based on qualitative analysis of interviews with physician, nurses, and patients. There is a high probability that this intervention can impact the quality of patient care in rural community-based primary care and has excellent potential for sustainability following the completion of the study. The specific aims include the following: Specific Aim 1: To test the effectiveness of the WISE Ql program to improve health care quality of high-risk rural patients with diabetes mellitus type 2. Specific Aim 2: To assess the impact of the WISE Ql program on the costs of care. Specific Aim 3: To identify the contextual factors (facilitators and barriers) that modify individual and program outcomes. [unreadable] [unreadable]